If we weren’t already convinced of the prevalence of opioid addiction in the U.S., a new study from Johns Hopkins lays out just how bad it’s gotten. The authors report that opioid prescriptions, which include OxyContin and morphine, have skyrocketed in the last decade, while pain identification and management has largely stayed the same. Opioid addiction and overdose are also creeping up. The study’s harsh reality comes at an interesting time, as the FDA has just announced its own stab at addressing the opioid problem, by urging their restriction to those who really truly seem to need round-the-clock pain management for extreme pain. What effect this will have remains to be seen, however, and some are not so convinced that it will have any.

“There is an epidemic of prescription opioid addiction and abuse in the United States,” said G. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “We felt it was important to examine whether or not this epidemic has coincided with improved identification and treatment of pain.”

The new study looked at doctor visits from 2000 to 2010 for people seeking relief from pain that was not cancer-related. In 2000, about half of all pain visits were treated with some sort of medication – this much was about the same in 2010, which saw about 164 million office visits for pain. What did change, however, was the number of people treated with non-opioid drugs versus opioid drugs: While non-opioid painkiller prescriptions stayed at about 26-29%, opioid prescriptions almost doubled from 11% to 20% over these 10 years.

The class of drugs is dangerous in part because they are so highly addictive, and the mortality rate from their use is rising. “By 2008,” wrote the Hopkins team, “the annual number of fatal drug poisonings surpassed those of motor vehicle deaths and overdose deaths attributable to prescription drugs exceeded those of cocaine and heroin combined.”

The irony is that the treatment of pain hasn’t improved much. And other drugs like acetaminophen and ibuprofen, which have far fewer safety concerns, seem to be flat or even dropping slightly, which, the authors say, “suggests that efforts to improve the identification and treatment of pain have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike.”

The solution to the problem is not clear, though the FDA has tried to address it. Last week, the FDA urged doctors to limit the use of the drugs in part by restricting prescriptions to those who have severe, rather than moderate, pain all the time, and in whom no other alternatives are possible. "The goal here was to make every patient taking extended-release and long-acting opioids to have a conversation about whether these products are helping them," said Douglas Throckmorton, an FDA deputy director. "I hope this encourages physicians and patients to be more thoughtful and more careful as they use these medications." The FDA also moved for drug companies to conduct studies to better understand risk over the long term, and investigation into how tolerance to the drugs may develop.

Though the new guidelines may have some effect, at least at calling out the problem once more for the medical community, it’s not clear how much it will really penetrate the current model of pain care. As The New York Timespoints out, the refusal of the FDA to require a cap on the length of the prescription still leaves it fairly open-ended, and “drug makers free to imply in their advertising that long-term use and high doses are acceptable.” Others, like New York City’s health commissioner Thomas Farley have lamented the FDA’s failure to take more aggressive measures at fixing the problem.

Perhaps the recommendations will help patients themselves be aware of the risks – of addiction, overdose, and death – before accepting prescription for the drugs from their doctors. But mostly, the future of opioid use is still unclear, and it may not change in tangible ways any time soon. “These regulatory changes may help prescribers and patients to better appreciate the risks of these therapies,” says Hopkins’ Matthew Daubresse. “Despite this, the ultimate impact of the FDA’s labeling change has yet to be seen.”